{"id":117713,"date":"2018-03-11T10:47:23","date_gmt":"2018-03-11T10:47:23","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/pronostico-a-corto-y-largo-plazo-de-los-pacientes-con-infarto-agudo-de-miocardio-y-bloqueo-de-rama\/"},"modified":"2018-03-11T10:47:23","modified_gmt":"2018-03-11T10:47:23","slug":"pronostico-a-corto-y-largo-plazo-de-los-pacientes-con-infarto-agudo-de-miocardio-y-bloqueo-de-rama","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/cardiologia\/pronostico-a-corto-y-largo-plazo-de-los-pacientes-con-infarto-agudo-de-miocardio-y-bloqueo-de-rama\/","title":{"rendered":"Pron\u00f3stico a corto y largo plazo de los pacientes con infarto agudo de miocardio y bloqueo de rama"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Leticia Jaulent Huertas <\/strong><\/h2>\n<p>Resumen en estudios de la era pre-reperfusi\u00f3n la presencia de bloqueo de rama (br) asociado a infarto agudo de miocardio (iam) se asoci\u00f3 a altas tasas de mortalidad a corto y largo plazo. Los cambios terap\u00e9uticos que se han producido en los \u00faltimos a\u00f1os, especialmente la aplicaci\u00f3n de la terapia de reperfusi\u00f3n, fibrinolisis y angioplastia primaria, se asocian a un beneficio en el pron\u00f3stico de los pacientes con iam.  objetivos conocer las caracter\u00edsticas cl\u00ednicas y el pron\u00f3stico a corto y largo plazo asociado a la presencia de br e iam atendiendo a la localizaci\u00f3n derecha o izquierda del br, al tiempo de aparici\u00f3n, y a la duraci\u00f3n, transitoria o permanente en el caso de los br de nueva aparici\u00f3n.  pacientes y m\u00e9todos estudio prospectivo de 5.570 pacientes ingresados consecutivamente por iam en dos unidades coronarias de dos hospitales de la regi\u00f3n de murcia durante un periodo de 10 a\u00f1os. Los pacientes fueron seguidos durante una mediana de 7,2 a\u00f1os. Se determin\u00f3 el hazard ratio a corto y largo plazo mediante modelos de regresi\u00f3n multivariable de cox.  resultados los br estuvieron presentes en 964 (17,3%) pacientes. De los cuales el 10,6% fueron bloqueos de rama derecha (brd), y el 6,7% bloqueos de rama izquierda (bri). Globalmente la mortalidad a los 30 d\u00edas fue del 13,2 % (n=738), y a los 7 a\u00f1os fue del  40,7% (n=2.268). Ambos, brd y bri fueron m\u00e1s frecuentemente previos, 42,9% y 58,8%. La presencia de br de nueva aparici\u00f3n fue m\u00e1s frecuente entre los brd 35,9% vs 27,0% en los bri. Comparados con los pacientes sin br, los pacientes con br se asociaron a mayor edad y alta preValencia de comorbilidades especialmente diabetes (49,0 vs 34,3%, p&lt;0,001), y mayores tasas de insuficiencia cardiaca durante la hospitalizaci\u00f3n (54,5 vs 26,6%, p&lt;0,001). Frente a los pacientes con brd los pacientes con bri mostraron mayores tasas de comorbilidades y recibieron en menor frecuencia tratamiento de reperfusi\u00f3n. En el an\u00e1lisis multivariable s\u00f3lo el brd (hr 1,27, ic 95% 1,11-1,45, p&lt;0,001) fue predictor independiente para la mortalidad a largo plazo.  frente a los pacientes con br previos e indeterminados, los pacientes con br de nueva aparici\u00f3n presentaron infartos m\u00e1s extensos, m\u00e1s complicaciones y mayores tasas de mortalidad a los 30 d\u00edas y a largo plazo. Entre los pacientes con br nuevos, los que presentaban br transitorio tuvieron menos tasas de insuficiencia cardiaca y menor mortalidad a corto y largo plazo que los pacientes con br nuevos y permanentes. el brd nuevo permanente fue predictor independientemente de mortalidad a los 30 d\u00edas (hr 2,01 ic 95% 1,45-2,79) y 7,2 a\u00f1os (hr 3,12 ic 95% 2,38-4,09). El bri nuevo y permanente result\u00f3 as\u00ed mismo predictor independiente de mortalidad a los 30 d\u00edas (hr 2,15 ic 95% 1,47-3,15) y 7,2 a\u00f1os (hr 2,91 ic 95% 2,08-4,08). conclusiones. En pacientes con iam, s\u00f3lo el brd fue predictor de mortalidad a largo plazo. Atendiendo a la antig\u00ed\u00bcedad y transitoriedad de los br, s\u00f3lo los brd y bri nuevos y permanentes resultaron predictores de mortalidad a corto y largo plazo.  abstract in studies of pre-reperfusion era the presence of bundle branch block (bbb) associated with acute myocardial infarction (ami) was associated with high mortality rate in the short and long term. Therapeutic changes that have emerged in recent years, especially the application of reperfusion therapy, fibrinolysis and primary angioplasty have been associated with a significant benefit with regards the prognosis of patients with ami. objectives to investigate whether the prognosis associated with bbb might be different depending on the location, time of appearance and duration in patients admitted with ami. patients and methods from 1st, january 1998 through january 2008, we prospectively recruited 5570 patients admitted with ami in two coronary care units of two hospitals in the region of murcia. Patients were followed for a median of 7.2 years. The hazard ratios in the short and long term were estimated by mean of multivariate cox regression models. results the bbb were present in 964 (17.3%) patients (10.6% were right bundle branch blocks (rbbb), and 6.7% left bundle branch block (lbbb) 6.7%). Overall 30-day mortality rate was 13.2 % (n=738) and 7-years was 40.7% (n=2268). Both, rbbb and lbbb were more frequently prior, 42.9% and 58.8%. The presence of new-onset bbb was more frequent among rbbb compared to lbbb (35.9 vs 27.0%, p&lt;0.001). Compared with non-bbb, all bbb groups showed higher prevalence of comorbidities, especially diabetes (49.0 vs 34.3%, p &lt;0.001), and more often heart failure during hospitalization (54.5 vs 26.6%, p &lt;0.001). Compared with rbbb, lbbb patients had higher prevalence of comorbidities, lower creatine-kinase mb, received less reperfusion therapy versus patients with rbbb and non-bbb patients. In the multivariate analysis, rbbb (hr 1.27, 95% ci 1.11 to 1.45, p &lt;0.001) was independent predictor of long-term mortality. compared to patients with previous and indeterminate bbb, new-onset bbb patients showed larger infarcts, experienced more frequently complications and showed higher mortality rates at 30 days and long-term. Among patients with new bbb, those with transient br had lower rates of heart failure and reduced mortality in the short and long-term compared to patients with new permanent bbb. the new permanent rbbb was an independent predictor of mortality at 30 days (hr 2.01 ci 1.45 to 2.79) and at 7.2 years (hr 3.12 ci 2.38 to 4.09). The new permanent lbbb was an independent predictor at 30 days (hr 2.15 ci 1.47 to 3.15) and at 7.2 years (hr 2.91 ci 2.08 to 4.08) of mortality. conclusions in patients with ami, rbbb was predictor of long-term mortality. Considering age and transience of bbb, only new permanent rbbb and lbbb were predictors of short and long-term mortality.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Pron\u00f3stico a corto y largo plazo de los pacientes con infarto agudo de miocardio y bloqueo de rama<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Pron\u00f3stico a corto y largo plazo de los pacientes con infarto agudo de miocardio y bloqueo de rama <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Leticia Jaulent Huertas <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 25\/06\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Jos\u00e9 Antonio Melgarejo Moreno<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: jose Galcera tomas <\/li>\n<li>Francisco Javier Gil sanchez (vocal)<\/li>\n<li>Miguel angel Fernandez-villaca\u00f1as marin (vocal)<\/li>\n<li>federico Soria arcos (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Leticia Jaulent Huertas Resumen en estudios de la era pre-reperfusi\u00f3n la presencia de bloqueo de rama (br) 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